PI: David Oslin, MD Title: Reducing the Burden of Depression on Employment: Improving Function and Work Abstract 1. Objective(s): Depression is a prevalent, often chronic condition that frequently limits ability to function at work, at home and in the community. In veteran and civilian populations, depression has been associated with excess unemployment, job loss, turnover, work absences and at-work performance deficits. Among Gulf War veterans, major depression and PTSD are leading reasons for service-connected disability benefits granted at the 100% level. Among OEF/OIF veterans with depression who are employed, at-work performance deficits and absences are four times higher than rates for depressed employees in the civilian population. At minimum, depression costs this nation $24 billion annually in lost productivity. With the goal of helping employed veterans with depression to participate fully in the labor market, this study has two objectives: test the effectiveness of a new evidence-based, vocationally-focused telephonic counseling program for employed veterans with depression, the Veterans -Work and Health Initiative (V-WHI), which was developed by this study's research partners from the Tufts Medical Center; and 2) if the V-WHI is effective, quantify its return on investment (ROI). The V-WHI will provide veterans with eight telephone counseling sessions to address barriers to effective functional performance at work. This study will test the impact of the V-WHI in combination with the VA's program of Integrated Care (IC) for depression. The V-WHI is based on two bodies of scientific literature. First, clinical research indicates that providng evidence-based depression diagnosis and treatment is helpful but not sufficient to reduce depression's negative employment and related functional deficits. Second, research on disability (and work disability specifically) suggests the potential benefits to both functioning and recovery by improving the fit between the employed person with depression and his or her work context. Thus, used in combination with the VA's IC services, which reflect VA/DOD Depression Guidelines for primary care, the V-WHI's functional improvement interventions are expected to improve veteran outcomes. 2. Research Design: A randomized controlled trial (RCT) will test the hypothesis that the V- WHI added to the IC will be superior to IC services alone. The primary endpoints are pre/post changes in at-work performance and productivity scores based on the validated Work Limitation Questionnaire (WLQ). Secondary endpoints include changes in depression symptom severity (measured with the validated PHQ-9) and healthcare utilization and costs. 3. Methodology: After eligibility screening and informed consent, subjects will be assigned to a combined program or IC only group. Initially, 250 employed veterans with depression and work limitations will be enrolled (half per group). Questionnaires will be administered at baseline, month four to five (post-intervention) and month nine. An ROI analysis will assess costs and benefits. This study will potentially benefit the VA and veterans by advancing the science and practice of functional improvement.